Arthroscopic surgery is a minimally invasive surgical procedure in which examination and treatment of damage to the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision. To access the interior of the joint, the surgeon creates arthroscopic portals and inserts cannulas through the patient's skin and through intervening layers of tissue and ligaments. The surgeon then introduces arthroscopic instruments through these access portals to perform the surgery. Creating access portals can be extremely challenging for the surgeon.
Creating access portals in hip arthroscopy, especially the first portal can be problematic. The surgeon carries out the first portal blind under 2D fluoroscopic imaging with no direct visualization through an arthroscope. Studies show that a majority of iatrogenic damage is created in the femoral head by the initial blind needle placement. Other problems arise from some of the hip structures, such as the articular cartilage on the femoral head, which is quite delicate. The surgeon must be careful when forming the access portal so as to not to these structures.
The capsule surrounding the hip joint is of particular concern. The capsule is leather-like being significantly denser and “tougher” than tissue externally surrounding the capsule. Even with a sharp needle, the surgeon must push relatively hard to pierce the capsule. However, the capsule is thin so the surgeon risks popping through the capsule, uncontrollably, and accidently damaging tissue beyond the capsule.
In view of the problems described above, there is a need to minimize the damage created by blind placement of the needle. More specifically, there is a need to control the penetration of the periarticular soft tissues and hip capsule by a needle without visual aid. These needs are addressed by a surgical needle with a movable stylet having a deformable tip. The stylet rapidly extends beyond a tip of a bevel of the surgical needle when the surgical needle does not have tissue pressing against its distal end. For example, the stylet extends just after the surgical needle exits the capsule but before contacting the femoral head. In case the stylet contacts the femoral head, accidently, the deformable tip inhibits damage to the femoral head.